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According to the 2001 Kurt Cobain biography Heavier Than Heaven by Charles R. Cross, Cobain wrote the lyrics to "Aneurysm" about his ex-girlfriend, musician Tobi Vail.[3] Cobain's lyrics for the song make fun of pop conventions and drug-use rituals ("shoot the shit"), ("beat me out of me").[4] Cobain's lyrics for the song allude to the first time he spent time with Tobi, when he got so nervous he had to throw up: "Love you so much, makes me sick!" He also wrote it as a dark love song to try to get her back and to describe how the break-up devastated him: "Come on over...do the twist, Overdo it...and have a fit!"[5]

The footage from the Live! Tonight! Sold Out!! video was used as a promotional video on music television for the Live! Tonight! Sold Out!! video in 1994 as well as for the From the Muddy Banks of the Wishkah album in 1996.